Cocchi A, Franceschini G, Antonelli Incalzi R, Farina G, Vecchio F M, Carbonin P U
Policlinico Universitario A. Gemelli, Istituto di Clinica Medica, Rome, Italy.
Age Ageing. 1988 Mar;17(2):87-93. doi: 10.1093/ageing/17.2.87.
A series of 200 consecutive patients with autopsy-proven acute myocardial infarction (AMI) was retrospectively studied in order to assess the degree of clinico-pathological agreement and to detect the reasons for disagreement. A correct clinical diagnosis of AMI was made in 86 cases (Group A = 43%) and was missed in 114 cases (Group B = 57%). Atypical presentation and concealed history were more common in group B. The AMI qualified to be the main disease in 83 patients of group A and in 81 of group B and was considered a contributory cause of death in three of group A and in 33 of group B (P less than 0.01). The mean number of diseases coexisting with the main disease for each patient was significantly lower in group A than in group B (P less than 0.01). The mean age was 65.2 +/- 12 years for group A patients and 69.1 +/- 12 years for group B patients (P less than 0.02). With the patients grouped according to age (group I: less than 60 years = 46 cases; group II: greater than or equal to 60 years = 154 cases), the diagnostic accuracy was 61% in group I and 38% in group II (P less than 0.01). Groups I and II did not differ in clinical presentation, ECG and enzyme diagnostic accuracy, while the number of diseases coexisting with the AMI was significantly higher in group II (P less than 0.001). Ageing, the atypical presentation and the coexistence of several diseases seem to account for most of the unrecognized AMI.
为评估临床病理一致性程度并找出不一致的原因，对连续200例经尸检证实为急性心肌梗死（AMI）的患者进行了回顾性研究。86例患者（A组 = 43%）被正确诊断为AMI，114例患者（B组 = 57%）漏诊。B组中不典型表现和隐匿病史更为常见。在A组的83例患者和B组的81例患者中，AMI被判定为主要疾病，在A组的3例患者和B组的33例患者中，AMI被认为是死亡的促成原因（P < 0.01）。A组每位患者与主要疾病并存的疾病平均数量显著低于B组（P < 0.01）。A组患者的平均年龄为65.2 ± 12岁，B组患者的平均年龄为69.1 ± 12岁（P < 0.02）。根据年龄将患者分组（I组：小于60岁 = 46例；II组：大于或等于60岁 = 154例），I组的诊断准确率为61%，II组为38%（P < 0.01）。I组和II组在临床表现、心电图和酶学诊断准确率方面无差异，而II组中与AMI并存的疾病数量显著更高（P < 0.001）。衰老、不典型表现和多种疾病并存似乎是大多数未被识别的AMI的原因。
